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Matt Leonard

4 Reasons To NEVER Give Your Home To Your Children

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Many people plan to continue to live in their home as long as they are able to do so. If they eventually ever have to go to a nursing home, your house and its contents would NOT have to be sold in order to qualify for Medicaid. However, it is still at risk because the state has a right to recover whatever it pays for your care from your probate estate. Your home may be protected from such estate recovery by keeping it out of your probate estate.

The simplest approach to doing so would be to deed it to your children. There are four problems with doing this:

  1. You lose control over your house. Your children now are the tile owners of the home and as such it would be subject to and vulnerable to your children’s debts or if they were sued or divorced.
  2. This would be a transfer which would make you ineligible for Medicaid for the following 60 months.
  3. Your children would lose the opportunity of getting a “step-up” in basis by receiving the property through your estate. Your children would be subject to potential capital gains taxes that could be avoided.
  4. Selling the home later can become problematic. Many clients expect at some point to need to sell their home and possibly downsize. By transferring the home to your children you have added complexity with title issues and taxation issues with any sale.

So how do you keep the house out of  your probate estate so that the state has no access to place a lien on it? How do you ensure your heirs get a stepped-up basis in the house? How should you own the house that allows for a ease of downsizing? There is one SOLUTION: using the Irrevocable Income Only Grantor Trust.

This trust allows you to keep the property out of your children’s hands, allows them to received a step-up in basis, allows you the freedom of selling the property without a hassle, avoids estate recovery and five years after the transfer is completely protected for Medicaid.

Want to lean more? Contact our office for a free consultation.elderly-couple-in-front-of-home-960x683

Can Long Term Care Insurance Work For More People?

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Long Term Care Insurance is a product known by few and used by fewer.

New research looks at trade offs in participation rates, cost and Medicaid savings. These factors must be reviewed when deciding on what is the best way to protect assets. But where does a person start?

The first step in the process is consulting with an estate planning attorney. During that consultation, an elder law estate planning attorney will be able to make an initial assessment of the client, their assets, prospective needs and overall goals. Clients should be advised during the consultation if long term care insurance is an option and then the elder law attorney should make a recommendation to you to meet with a long term care insurance representative to review products available. Unfortunately, because of economic or health reasons few people can consider pursing long term care policies.

Follow the below link that discusses the findings of some recently completed new research that looks at tradeoffs in long-term care insurance participation rates, cost, and Medicaid savings.

The attached article suggests that when someone turns 65 in America today, there’s about a 50-50 chance he or she will need not just medical care as they get older, but extensive help with basic activities like dressing, bathing, walking and eating. Expenses associated with caring for individuals on average are between$91,000 and $182,000, but they can range much higher, too.

People who seek out long term care insurance cite the peace of mind knowing they are prepared for whatever life brings them. The long term care insurance industry struggles to make these policies viable for more individuals and if successful, it will have broad impact on Medicaid.

http://www.nextavenue.org/how-to-get-more-people-covered-by-long-term-care-insurance/

Document of Insurance Policy, Life; Health, car, travel, for background

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Who Receives Skilled Nursing Care and Where in Rhode Island?

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Skilled Nursing Care Demographics in Rhode Island

Nearly 8,000 people reside in Rhode Island’s 84 nursing homes and skilled nursing care facilities at any single point in time.

They are mostly independent facilities (60.7%), although a large minority belong to a multi-facility organization (39.3%). Nearly eight in 10 (78.6%) RI nursing homes are for-profit.

Residents are predominantly female (72.1%) and non-Hispanic white (93.4%).

More than half (55.5%) are aged 75 or older.

In 2012, RI nursing home costs averaged $8,517 per month for a shared room and $9,277 per month for a private room. Source: Rhode Island Journal of Medicine: The Nuts and Bolts of Long-Term Care in Rhode Island: Demographics, Services and Costs (March 2015)

WHAT ABOUT BEING ABLE TO RECEIVE CARE AT HOME UNDER THE MEDICAID WAIVER PROGRAM?

Rhode Island has a program called SSI Enhanced Assisted Living Program that provides up to approximately $1,200 / month to be put toward the cost of assisted living. However, this is not a Medicaid program. RI does have a Medicaid program called RIte @ Home which offers 24/7 personal care in a residential environment but not in assisted living communities. Finally, the state’s Home and Community Care Medicaid Waiver also covers assisted living.

NursingHome

Nursing Home Demographics

Elderly Rhode Island residents can receive a variety of care services and support through the Home and Community Care Program. This program is intended as an alternative to nursing homes.  The services are provided to individuals living at home or “in the community”. By the rules of the program, “in the community” includes assisted living residences. The benefits of the program are designed to support individuals at home. This program provides adult day care, in-home care, meal delivery services and medical alert services.

This program is under the jurisdiction of the Rhode Island Division of Elderly Affairs and is funded through a combination of state and federal monies.

Want to learn more about how nursing home skilled nursing and the Waiver Program may impact you and your family? Contact our office for a free consultation.

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How Do People Pay For Nursing Home Care In Rhode Island?

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What do you mean my health insurance does not pay for nursing home care?

There are 3 major ways on how people pay for nursing home care in Rhode Island:

First is by accessing and using an earlier purchased long-term-care insurance policy. Unfortunately, very few people have them as they are for many people cost prohibitive.

The second way is by private pay, which means you write a check directly to the nursing home from your life savings to pay for the room and board to live there. Per the Rhode Island Department of Human Services, the average cost per month for skilled nursing home care in Rhode Island is $9,113.

The third way to pay for nursing care is to qualify for Medicaid coverage under the Medicaid program. By qualifying for Medicaid, an individual will not be required to spend their life savings on skilled nursing care.

Unfortunately, medical insurance does not pay for long term care. Most plans will only pay a portion of the first 100 days of skilled care. After the 100 days is used, individuals will need be responsible for paying for their own room and board – their medical insurance will continue to pay for doctor visits and prescriptions, but individuals will need to pay for the bed, meals and roof over their head in nursing home.

How do I qualify for Medicaid?

Qualifying for Medicaid is like filing a very complicated tax return over a series of years. For a person to take advantage of the tax rules the taxpayer needs to make decisions as to their assets and income, perhaps transferring assets or claiming some while using others. So too is it with qualifying for Medicaid. As a CPA helps with a Tax Return, and Elder Law Attorney helps with understanding and advising as to what needs to be done to qualify for Medicaid. It is a lengthy process that for it to be optimized requires 5 years!

Want to learn how to qualify for Medicaid? Contact our office and schedule a no-cost meeting!Nursing Home Image

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One Quarter of America’s Caregivers Are Millennials

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Who are the caregivers looking over our loved ones?

Caring for older relatives is usually a task associated with Baby Boomers, the 50- and 60-somethings who find their aging parents need assistance. But almost a quarter of the adults who take care of older people — on top of their regular jobs and responsibilities — are between the ages of 18 and 34, according to research by the AARP Policy Institute and the National Alliance for Caregiving.

As millions of Americans are expected to live longer than they used to — often losing the ability to do so independently — their families and communities are grappling with how best way to take care of them. Kaiser Health News focused on the problem in a Dec. 2 webinar with advocates and policymakers. About 40 million Americans considered themselves caregivers in 2013, according to an AARP report, said Susan Reinhard, senior vice president at the AARP and one of the webinar’s panelists. Those people are typically women, and their median age is 49. The work they do caring for older relatives — usually parents and grandparents — was estimated that same year to be worth about $470 billion.Caregiver

The study underlines the importance of having a plan in place.

As we live longer lives, it is up to each person to ensure they have
a plan on how they will handle those years. Discussions need to include topics of domicile, care givers, support with daily activities of living, financial and medical.

Need to start your conversation? Contact us to schedule a meeting.

Source: Kaiser Health News

 

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Leaving Nursing Home During Medicare-Covered Stay

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LEAVING NURSING HOME WHILE STILL BEING TREATED – IS IT POSSIBLE?

Nursing home residents often want to participate in holiday gatherings but may worry they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends can put their minds at ease. According to Medicare law, nursing home residents may leave their facility for family events without losing their Medicare coverage.leaving hospital

However, depending on the length of their absence, beneficiaries may be charged a “bed hold” fee by their skilled nursing facility (SNF). The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, “an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care…Decisions in these cases should be based on information reflecting the care needed and received by the patient while in the SNF and on the arrangements needed for the provision, if any, of this care during any absences.”

Source: Center for Medicare Advocacy

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Couples Fight More About Finances as Retirement Draws Closer

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Couples Fight More About Finances before Retirement – No Duh?!

Interesting article about the stress retirement and finances can put on couples.  It is CRITICAL that couples put together a PLAN that address their concerns with specific details to protect and preserve their finances and assets.  We are happy to meet with you to discuss how we can protect your assets and take the stress out of retirement.

http://www.nbcnews.com/business/retirement/couples-fight-more-about-finances-retirement-draws-closer-n473551?utm_source=PBN+Master+List+-+All+Subscribers&utm_campaign=ea799b1b17-2015_1204_call12_3_2015&utm_medium=email&utm_term=0_0e86591c9b-ea799b1b17-29917329

as-retirement-approaches-article

 

There is an old adage: A FAILURE TO PLAN IS A PLAN TO FAIL.

This is true with most aspects of life but most especially with finances. Too often people wait too long to face the economic realities of retirement. The thought being I will just earn as much as I can during my working days and hope it holds me is simply not enough. People do not need to live in the dark or in fear. Meeting with a financial planner who can model out your lifestyle and the costs associates with it will be helpful in determining if you need to make adjustments.

The other aspect of finances is seeking to protect them. If you learned that you would need to spend over $109,000 per year on a spouse and their care in 3 years, would you do anything different today? The answer to that is a most definite YES. Should one of you require skilled care, it costs over $109,000 per year and is not covered by insurance, thus a plan for that expense is critical for the healthy spouses financial future.

Want to discuss your plan? Contact us for a free consultation.

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What is the Medicaid Global Waiver?

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What is the Medicaid Global Waiver?

The Medicaid Global Waiver is an agreement with the federal government about how Medicaid money is spent. Medicaid, a program that funds health services for qualified elderly, disabled, children, and families, is paid for by both the federal and state governments. Under this new agreement, the federal government will relax its Medicaid rules to allow Rhode Island to spend federal Medicaid money on a broader range of services through streamlined administrative processes that would not have been possible without the Medicaid Global Waiver.

Why the Waiver program?

The significance of this is intended to provide greater flexibility to provide services to needy Rhode Island residents in a lower cost setting. Allowing for state provided services in home with the hope of providing better care for the individual and greater savings to the taxpayer.

Want to learn how to qualify for Medicaid benefits? Contact our office for a free consultation.rhode_island_medicaid_waiver

Global Waiver Questions & Answers

What is the Medicaid Global Waiver?

The Medicaid Global Waiver is an agreement with the federal government about how Medicaid money is spent. Medicaid, a program that funds health services for qualified elderly, disabled, children, and families, is paid for by both the federal and state governments. Under this new agreement, the federal government will relax its Medicaid rules to allow Rhode Island to spend federal Medicaid money on a broader range of services through streamlined administrative processes that would not have been possible without the Medicaid Global Waiver.

 

  • Why does Rhode Island need this waiver?

Under the current system, federal rules governing how Medicaid money can be spent do not allow for the healthcare innovations Rhode Island envisions. The Global Waiver will facilitate increased consumer responsibility and choice, more emphasis on prevention and wellness, greater reliance on home and community based care as opposed to institutional care, and simplified administration of the Medicaid dollars.

 

Along with improved health care the waiver is needed to ensure that Medicaid programs remain affordable. Medicaid spending accounts for 25% of the state budget and is growing at a rate of 7% a year. With state revenue only growing at a 1.8% rate, it is easy to see that Medicaid spending is outpacing our ability to pay. That means that without changing the way we provide and pay for Medicaid services, those services are in danger of being lost. By receiving this Global Medicaid Waiver, Rhode Island will be able to preserve and improve services while keeping them affordable.

 

  • What if the recession worsens and more and more people become eligible? Will RI run out of money?

The secondary purpose of the Global Waiver is to make Medicaid programs more affordable. So, the expectation is that RI will be saving money and, ultimately, be able to serve more people. In other words, RI will better handle an influx of people into Medicaid programs through the Global Waiver than under the existing system. Although the Global Waiver has planned for many contingencies, if unforeseen and emergent conditions arise that make the Global Waiver unworkable, the State may suspend or terminate the Global Waiver.

 

  • Will people who now receive Medicaid-funded services lose them?

No. The State of Rhode Island is bound to follow the eligibility rules that were in place as of November 1, 2008. These eligibility rules cannot be easily changed; any changes must be approved by the state legislature and the federal government.

  • Will the Governor unilaterally change eligibility for certain populations?

The Governor cannot act alone without public input and legislative approval.

 

  • Will people in nursing homes be forced to leave?

No. Anyone who is in a nursing home and continues to need a nursing home can stay in the nursing home. With this new waiver, the goal is that people will not be forced to go into nursing homes because they lack choices. The Global Waiver will enable the State of Rhode Island to develop options for people so that more can stay in their homes with the proper supports if they so choose. Under the old Medicaid rules, this was not possible; now, Medicaid money will pay for more home and community-based care options.

 

  • Will the global waiver offer protection from a waiting list for seniors currently eligible for nursing home services?

There is no waiting list now for nursing homes and no waiting list is anticipated under the waiver. Anyone who needs nursing home level of care will receive it.

 

  • How will this relate to residents in assisted living that are currently on an existing waiver now?

Residents in assisted living can remain in assisted living if they so choose. Under the current system, there are limited assisted living slots. Because the Global Medicaid Waiver merges all waivers, it will open up the number of assisted living slots. In addition, the “selected contracting provision” in the Global Medicaid Waiver has the potential of paying certain kinds of assisted living differently, further opening more assisted living beds.

 

  • What is the timetable for these programs?

The Medicaid system as we know it has grown over the last forty years. Reforming that system and making it more affordable will not happen overnight; that will take a few years. The first order of business is legislative approval. After that, the Assessment Team will be assembled and new levels of care will be drafted so that Assessment Services will be operating by July 1. In the meantime, departments will be working with providers to offer more home and community based services.

 

  • Will there be public hearings?

Yes. This is really a community effort and the input of the public will be sought – as it has been – in addition to the legislative hearings.

 

  • Does the waiver conflict with any state laws?

No. The waiver must conform to all state and federal laws. Changes in the Medicaid program cannot be made without public notice and legislative approval.

 

  • How many different waiting lists will there be?

There are already waiting lists for some Medicaid-funded services. That will not change initially, but the goal of the Medicaid reforms made possible by the Global Waiver is to eliminate waiting lists.

 

  • Who will decide whether or not a person requires nursing home or residential care?

There are already state regulations that dictate whether or not a person requires residential care. The new Global Waiver will make two differences. First of all, there will now be more alternatives to residential care so that even if a person requires a high level of care, it may be possible for him/her to receive that care in the home and community. Secondly, an assessment team of medical and social service professionals will be created that will now include the individual and family in the decision-making so that all the options can be studied and the best one chosen.

 

  • What happens if a person or family disagrees with the assessment team’s decision about what kind of care is recommended and would be paid for?

People will be able to appeal any decision to an independent board.

 

  • What criteria are used to decide if a person needs residential care?

People are assessed for their skilled needs or their ability to perform what are called, Adult Daily Living Skills. If they require extensive or total dependence they are eligible for nursing home care. Now, with the Global Waiver, more supports will be created that will assist people with these Daily Living Skills in their home or in less restrictive settings.

 

  • If more than one person in the family qualifies for Medicaid help is there a preference given to keep them in their homes?

The advantage of the Global Waiver is that families can be assessed as a unit and not according to separate programs. Standards will be set for these sorts of situations, but the family will also be able to weigh in on the decision.

 

  • Are there any built-in preferences in this system? (Who gets help first?)

Priority is based on medical necessity; those in need of the highest level of care get priority.

 

  • We’ve heard that you’re considering a proposal for the Alliance for Better Long Term Care to send staff into nursing homes to identify candidates for return to the community and do assessments. Is that so, and what can you share with us about that?

The Alliance for Better Long Term Care has been contracted to bring good news to people in nursing homes who might want to live in their own homes or more independently. No one who is in a nursing home will be asked or forced to leave. However, those who want and are able to leave nursing homes due to new home and community based options may do so if they so choose.

 

  • Isn’t there a nursing shortage in RI? Where will all these home care professionals come from?

Now that money is available for a different range of services, agencies and companies will make the commitment to expanding services and staff. With new opportunities created, smart companies will move toward training and recruitment to take advantage of the Global Waiver.

 

  • What kinds of home and community based services are envisioned by this Global Waiver?

They would include: housekeeping, nutrition, nursing care, medication management, financial management, medical transportation, physical and occupational therapy, day care, home companions, coordinated medical care, assisted living and other non-institutional living arrangements.

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What is Medicaid?

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What is Medicaid?

The Rhode Island Medical Assistance Program, also known as “Medicaid”, is a Federal and state funded program that pays for medical and health related services for eligible Rhode Islanders. This includes inpatient and outpatient hospital care, preventive services, durable medical equipment, and many more services and benefits.

In order to qualify for this benefit program, you must be a resident of the state of Rhode Island, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in your household with a disability, or be 65 years of age or older.

What is Medicaid Planning?

Medicaid Planning is a form of estate planning where assets of an individual are transferred into various trusts and five (5) years after the transfer the individual would be eligible for Medicaid.

Qualifying for Medicaid is based on medical needs and assets. Applying for Medicaid is a cumbersome process, a long application that is often intimidating to many first time applicants. People often ask about qualifying for Medicaid – that process as mentioned earlier, is one that requires strict attention to the rules of eligibility and being careful with asset transfers.

Want to learn more? Contact us to schedule an appointment.

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12 Things To Know About Medicaid In Rhode Island

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12 Things to Know About Medicaid In Rhode Island

This is a fantastic recap of the economics and demographics of the Medicaid Program in Rhode Island. I highly recommend all citizens understand the scope and scale of the program in Rhode Island.

http://wpri.com/2014/12/08/12-things-to-know-about-medicaid-in-rhode-island/

1. Rhode Island spends a ton of money on Medicaid every year.

Rhode Island spent $1.785 billion on Medicaid in the 12-month fiscal year that ended June 30, 2013; the total state budget that year was $8.1 billion.

Slightly more than half the money spent on Medicaid services usually comes from the federal government, with the rest covered by taxpayers in Rhode Island.

Here’s a chart showing the annual cost of Medicaid in Rhode Island over the five fiscal years through 2012-13:

Nesi Medicaid chart 1 12-8-2014

2. Nearly one in four Rhode Islanders used Medicaid in recent years.

Part of why Medicaid is such an expensive program is because it’s such a large one. During the 2012-13 fiscal year, 22% of Rhode Island’s population – about 230,000 of the state’s roughly 1 million residents – used Medicaid at some point in the year.

Since there’s some amount of “churn” in Medicaid throughout the year – people signing up, people dropping off – the average number of Rhode Islanders signed up for Medicaid at any point in the fiscal year was somewhat lower: 195,000.

3. Rhode Island spends more per Medicaid enrollee than most states.

Or at least it did as of 2008-09, according to this chart from the Center on Budget and Policy Priorities, a liberal research group:

Nesi Medicaid chart 12 12-8-2014 via CBPP

All the states in the Northeast spent more on Medicaid per beneficiary than the national average, with the exception of Vermont.

4. Obamacare is expanding the Medicaid program significantly.

The Affordable Care Act – Obamacare – expanded eligibility for Medicaid. Unsurprisingly, that has led to a surge in enrollment and will lead to a surge in spending on the program.

Rhode Island’s total spending on Medicaid is projected to be $2.7 billion in the current fiscal year, which runs through June 30, 2015 – an increase of nearly $1 billion from two years earlier. Enrollment is projected to jump from about 190,000 residents at the end of last year to 261,828 residents as of this past summer. The federal government is picking up much of the tab for newly eligible enrollees, however.

Here’s a chart showing that Medicaid spending is projected to consume nearly one-third of Rhode Island’s general revenue (basically, taxes and fees paid in the state) in this year’s budget:

Nesi Medicaid chart 2 12-8-2014

5. Nearly half of Medicaid spending goes to hospitals and nursing facilities.

This chart is pretty self-explanatory:

Nesi Medicaid chart 10 12-8-2014

As the figures at the bottom of the chart show, there’s a big difference in how fast costs have been going up annually between different types of Medicaid providers in Rhode Island.

6. The majority of Medicaid spending is for elderly and disabled residents.

The stereotypical Medicaid beneficiaries are single mothers and their children, and for good reason – in Rhode Island, they made up two-thirds of those who used the program (134,383) in the 2012-13 fiscal year. Their share is up to roughly 80% post-Obamacare, state officials report.

However, children and families aren’t where most of the Medicaid money is spent – not by a long shot.

Elderly Rhode Islanders accounted for just 9% of Medicaid enrollees (18,077 residents) but 27% of Medicaid spending ($484 million) in 2012-13. Similarly, disabled adult Rhode Islanders accounted for just 16% of Medicaid enrollees (30,987 residents) but 37% of Medicaid spending ($667 million).

It cost Medicaid $2,230 per member per month to cover elderly Rhode Islanders and $1,793 per member per month to cover disabled adult Rhode Islanders in 2012-13. It only cost $288 per member per month to cover Rhode Island children and families; they’re relatively cheap to cover.

Here’s the breakdown of spending on the four subgroups of Medicaid beneficiaries:

Nesi Medicaid chart 3 12-8-2014

Put succinctly, the majority of people on Medicaid are children and families, but the majority of Medicaid spending is on elderly and disabled adult residents.

7. Rhode Island Medicaid spending on its two priciest groups is above average.

In 2011, Rhode Island’s Medicaid program spent 68% more than the national average for elderly residents and 15% more for disabled adult residents. These costlier-to-cover groups also made up a larger share of Rhode Island’s Medicaid enrollment:

Nesi Medicaid chart 4 12-8-2014

8. Spending per Medicaid enrollee has been falling, except for the elderly.

Rhode Island’s total Medicaid spending rose an average of 1.3% a year between the state’s 2008-09 to 2012-13 fiscal years, and actually fell by 1.5% per enrollee over that period.

The outlier was elderly residents, the only group for whom cost-per-member rose over that period, as this chart shows:

Nesi Medicaid chart 5 12-8-2014

9. Two-thirds of Medicaid spending on the elderly goes to nursing facilities.

“Most of the growth in Medicaid expenditure for elders has been in nursing home services and home and community based services,” the executive office explains in its report. “The increase in home and community based services is due in part to an effort to invest in alternatives to institutional/nursing home care.”

Nesi Medicaid chart 6 12-8-2014

And here’s a chart showing the same breakdown for adults with disabilities:

Nesi Medicaid chart 7 12-8-201410. Just 7% of Rhode Island Medicaid enrollees cost more than $1 billion a year.

This may be the most astounding fact on this page: the top 7% of Medicaid beneficiaries account for nearly two-thirds of spending on medical claims.

Put another way, out of the roughly 230,000 Rhode Island residents who used Medicaid during the 2012-13 fiscal year, on average one group of about 119,000 filed only $992 each in medical claims, while another group of about 16,000 (that top 7%) filed $66,000 each in claims.

“These high utilizers typically present with multiple, complex conditions, requiring care coordination across a variety of providers,” the executive office’s report explains.

Here’s a chart:

Nesi Medicaid chart 8 12-8-2014

So where did all that money go? “Nearly half (49%) of claims expenditure on high cost users is on nursing facilities and residential and rehabilitation services for persons with developmental disabilities,” the report says. It also says: “Many high cost users are those who are institutionalized year-round.”

Here’s a chart on that:

Nesi Medicaid chart 9 12-8-2014

11. Officials say Medicaid is a key reason Rhode Island faces large deficits.

The House Fiscal Office is projecting a larger budget shortfall in each of the coming fiscal years, according to these estimates provided to state lawmakers last month:

Nesi Medicaid chart 11 12-8-2014

12. Growing Medicaid costs are a key concern to state officials.

The same House Fiscal presentation singled out Medicaid for growing far faster than state revenue:

Nesi Medicaid chart 12 12-8-2014

13. Check out this Nesi’s Notes post featuring some interesting feedback to the Medicaid numbers.